HCMG 250 Midterm Exam 100% Solved!!
what does the reconcilliation bill want - ANSWERSdrug pricing reform for Medicare to
be able to negotiate prices
Where does Medicare drug pricing reform savings go towards - ANSWERSenhancing
Medicare benefits and extending the expansion of the ACA exchanges
how much does the US account for global drug spending - ANSWERS40%
how much is the global drug spending - ANSWERS$1 trillion
how does US drug prices compare to the rest of the world - ANSWERSdouble those of
australia, canada, and UK
how much does the US spend on retail and nonretail drugs per capita compared to
sqitzxerland - ANSWERStwice as much
switzerland is the country with the next highest spending
HR3 - ANSWERSdrug pricing proposal that was reintroduced to congress
what does HR3 call for - ANSWERSrequirement for HHS to negotiate maximum prices
for brand-name drugs that account for the greatest spending
negotiated prices must be offered under Medicare and may be offered by private
insurance as well
maximum launch price is determined by reference to prices charge in other countries
(external reference pricing)
requirement for rebates on Medicare prescription drugs if prices are rising faster than
inflation
Wynden's principles for drug pricing reform - ANSWERSMedicare must have the
authority to negotiate with pharmaceutical companies on drug prices
American consumers must pay less at the pharmacy counter when purchasing drugs
prices of drugs that increase faster than inflation will not be subsidized by patients and
tax payers
drug pricing reforms that keep prices and patient costs in check should extend beyond
Medicare to all Americans
,drug pricing should reward scientific innovation, not gaming of the patent system
what are people's opinions about lower drug costs - ANSWERSmost adults favor it
what percentage of people on Medicare do not have dental coverage - ANSWERS47%
higher in minorities and low income
American Rescue Plan - ANSWERSgave tax credits and ACA premium subsidies to
increase coverage for the uninsured
3 reasons why people need health insurance - ANSWERS1. protect against large
financial losses
2. reduce barriers for seeking, accessing, and utilizing medical services
3. increase predictability of costs and utilization through pooling (consumption
smoothing)
percent of population that spends 50% of total healthcare spending - ANSWERStop 5%
percent of population that spends 80% of total healthcare spending - ANSWERStop
20%
percent of population that spends 3.2% of total healthcare spending - ANSWERSbottom
50%
most people are not spending a lot of healthcare, mainly just a small group
what fraction of people with private insurance do not submit a claim - ANSWERS1/3
do employed or nonemployed have a higher mean expenditure - ANSWERSnot
employed
employed people tend to be more healthy in order to work
3 patterns of individual's likelihood to spend and use health services - ANSWERSolder
people use more
employed people use less
people with chronic illnesses use more
why do insurance companies want greater predictability - ANSWERSless risk of
catastrophic loss
,can leverage predictability to plan and guard against financial loss
The first medical insurance in the US was developed to - ANSWERShelp teachers pay
for medical care and assure hospitals were paid for delivered services (great depression
during this time)
Baylor Pre-Payment Plan (year and plan) - ANSWERS1929
plan for teachers who paid $6/year for 21 days of hospitalization/year
blue cross - ANSWERSHospital-based and community-based pre-payment plans grew
and organized into the Blue Cross Association
why did states exempt hospital service plans from reserve requirements -
ANSWERSdid not need it since they already had the goods to use (hospital beds) so
did not need reserves
why were doctors opposed to insurance programs - ANSWERSWorried about someone
stepping in between doctor and the patient
insurance = control
blue shield benefits - ANSWERSprovided service benefits for home and office visits and
doctors' services in the hospital
what was blue shield exempt from - ANSWERSfinancial reserve
nonprofit
what did blue shield require - ANSWERSrequired plan to be doctor controlled
what happened in WW2 - ANSWERSwage and price controls prevented employers
from raising wages to compete for workers
what was exempt from the wage controls - ANSWERS1942
fringe benefits were exempt
how could employers compete for employees during WW2 - ANSWERSoffering more
attractive health benefit packages
this grew ESI throughout the 1940s
what grew ESI throughout the 1940s - ANSWERSwage free exemption
, tax exemption
Integrated Health Systems - ANSWERSmanaged care organizations (direct service
prepaid group practices)
made by Kaiser to provide comprehensive health services
employed their own physicians and owned their own hospitals
why did doctors hate integrated health systems - ANSWERSsaw them as a threat to
independence and business
McCarran-Ferguson Act - ANSWERSexempted the business of insurance from federal
regulation governing:
coverage standards, premiums, policy language and implementation, financial reserves,
accounting standards, marketing, and variation across markets
Health Insurance Tax Exclusion - ANSWERSEmployer contributions for health
insurance were excluded from taxable income
Health insurance became a cheaper way for employers to compensate their workers
what led to the health insurance tax exclusion - ANSWERS1954: Revision to the
Internal Revenue Code
why is ESI regressive - ANSWERSESI premiums are not income linked
premium is the same regardless of income
who benefits the most from tax exclusion - ANSWERStop quartile of income (rich
people) get greater tax benefit from the ESI tax exclusion
4 reasons why are lower income earners disadvantaged for ESI - ANSWERSless likely
to have jobs that offer health coverage
pay a higher share of wages in premiums
less likely to participate in plans because they can't afford to pay premiums
lower tax bracket so the exemption provides less dollar benefit
*oversubsidizing for high income and undersubsidizing for lower income
what are the 4 advantages of for profit, commerical health insurance - ANSWERS1. one
stop shop (multiple forms of insurance - not just health)
what does the reconcilliation bill want - ANSWERSdrug pricing reform for Medicare to
be able to negotiate prices
Where does Medicare drug pricing reform savings go towards - ANSWERSenhancing
Medicare benefits and extending the expansion of the ACA exchanges
how much does the US account for global drug spending - ANSWERS40%
how much is the global drug spending - ANSWERS$1 trillion
how does US drug prices compare to the rest of the world - ANSWERSdouble those of
australia, canada, and UK
how much does the US spend on retail and nonretail drugs per capita compared to
sqitzxerland - ANSWERStwice as much
switzerland is the country with the next highest spending
HR3 - ANSWERSdrug pricing proposal that was reintroduced to congress
what does HR3 call for - ANSWERSrequirement for HHS to negotiate maximum prices
for brand-name drugs that account for the greatest spending
negotiated prices must be offered under Medicare and may be offered by private
insurance as well
maximum launch price is determined by reference to prices charge in other countries
(external reference pricing)
requirement for rebates on Medicare prescription drugs if prices are rising faster than
inflation
Wynden's principles for drug pricing reform - ANSWERSMedicare must have the
authority to negotiate with pharmaceutical companies on drug prices
American consumers must pay less at the pharmacy counter when purchasing drugs
prices of drugs that increase faster than inflation will not be subsidized by patients and
tax payers
drug pricing reforms that keep prices and patient costs in check should extend beyond
Medicare to all Americans
,drug pricing should reward scientific innovation, not gaming of the patent system
what are people's opinions about lower drug costs - ANSWERSmost adults favor it
what percentage of people on Medicare do not have dental coverage - ANSWERS47%
higher in minorities and low income
American Rescue Plan - ANSWERSgave tax credits and ACA premium subsidies to
increase coverage for the uninsured
3 reasons why people need health insurance - ANSWERS1. protect against large
financial losses
2. reduce barriers for seeking, accessing, and utilizing medical services
3. increase predictability of costs and utilization through pooling (consumption
smoothing)
percent of population that spends 50% of total healthcare spending - ANSWERStop 5%
percent of population that spends 80% of total healthcare spending - ANSWERStop
20%
percent of population that spends 3.2% of total healthcare spending - ANSWERSbottom
50%
most people are not spending a lot of healthcare, mainly just a small group
what fraction of people with private insurance do not submit a claim - ANSWERS1/3
do employed or nonemployed have a higher mean expenditure - ANSWERSnot
employed
employed people tend to be more healthy in order to work
3 patterns of individual's likelihood to spend and use health services - ANSWERSolder
people use more
employed people use less
people with chronic illnesses use more
why do insurance companies want greater predictability - ANSWERSless risk of
catastrophic loss
,can leverage predictability to plan and guard against financial loss
The first medical insurance in the US was developed to - ANSWERShelp teachers pay
for medical care and assure hospitals were paid for delivered services (great depression
during this time)
Baylor Pre-Payment Plan (year and plan) - ANSWERS1929
plan for teachers who paid $6/year for 21 days of hospitalization/year
blue cross - ANSWERSHospital-based and community-based pre-payment plans grew
and organized into the Blue Cross Association
why did states exempt hospital service plans from reserve requirements -
ANSWERSdid not need it since they already had the goods to use (hospital beds) so
did not need reserves
why were doctors opposed to insurance programs - ANSWERSWorried about someone
stepping in between doctor and the patient
insurance = control
blue shield benefits - ANSWERSprovided service benefits for home and office visits and
doctors' services in the hospital
what was blue shield exempt from - ANSWERSfinancial reserve
nonprofit
what did blue shield require - ANSWERSrequired plan to be doctor controlled
what happened in WW2 - ANSWERSwage and price controls prevented employers
from raising wages to compete for workers
what was exempt from the wage controls - ANSWERS1942
fringe benefits were exempt
how could employers compete for employees during WW2 - ANSWERSoffering more
attractive health benefit packages
this grew ESI throughout the 1940s
what grew ESI throughout the 1940s - ANSWERSwage free exemption
, tax exemption
Integrated Health Systems - ANSWERSmanaged care organizations (direct service
prepaid group practices)
made by Kaiser to provide comprehensive health services
employed their own physicians and owned their own hospitals
why did doctors hate integrated health systems - ANSWERSsaw them as a threat to
independence and business
McCarran-Ferguson Act - ANSWERSexempted the business of insurance from federal
regulation governing:
coverage standards, premiums, policy language and implementation, financial reserves,
accounting standards, marketing, and variation across markets
Health Insurance Tax Exclusion - ANSWERSEmployer contributions for health
insurance were excluded from taxable income
Health insurance became a cheaper way for employers to compensate their workers
what led to the health insurance tax exclusion - ANSWERS1954: Revision to the
Internal Revenue Code
why is ESI regressive - ANSWERSESI premiums are not income linked
premium is the same regardless of income
who benefits the most from tax exclusion - ANSWERStop quartile of income (rich
people) get greater tax benefit from the ESI tax exclusion
4 reasons why are lower income earners disadvantaged for ESI - ANSWERSless likely
to have jobs that offer health coverage
pay a higher share of wages in premiums
less likely to participate in plans because they can't afford to pay premiums
lower tax bracket so the exemption provides less dollar benefit
*oversubsidizing for high income and undersubsidizing for lower income
what are the 4 advantages of for profit, commerical health insurance - ANSWERS1. one
stop shop (multiple forms of insurance - not just health)
